اسپلنکتومی

Fever and neutropenia are common complications and significant causes of hospitalization in cancer patients. These conditions can increase the mortality rates among patients. The aim of this study was to investigate the etiologies of fever in neutropenic cancer patients admitted to the teaching hospitals affiliated with Abadan University of Medical Sciences.

This study was a descriptive-analytical, retrospective investigation. A total of 206 cancer patients presenting with fever and neutropenia, who were referred to the teaching hospitals affiliated with Abadan University of Medical Sciences in 2022, were included in the study. Patient information was collected through medical records and data retrieved from the Hospital Information System (HIS) using a structured checklist, and subsequently analyzed statistically.

The mean body temperature in patients who had received chemotherapy was significantly higher than that in patients who had not undergone chemotherapy (P<0.001). The mean temperature of patients with a fever duration of more than five days was also significantly higher than that of patients with a fever duration of less than five days (P= 0.024). A significant and inverse relationship was observed between body temperature and white blood cell (WBC) count on both the first and last day (P= 0.001 and P= 0.01, respectively). In addition, there was a significant and inverse relationship between body temperature and neutrophil count on both the first and last day (both P = 0.04). A significant relationship was also found between splenectomy and body temperature in patients with fever and neutropenia (P< 0.001).

Overall, fever duration, chemotherapy, and splenectomy were significantly associated with elevated body temperature. In addition, the findings indicated that neutrophil and white blood cell counts on both the first and last day were significantly associated with body temperature, such that this relationship was inverse, a decrease in neutrophils and white blood cells was associated with an increase in temperature.

This study aims to investigate the necessity of simultaneous cholecystectomy in thalassemia major patients undergoing splenectomy, in light of reports regarding the prevalence of gallstones in these patients and the overall incidence of the disease in Mazandaran.

This study was conducted on all 247 patients with beta-thalassemia major, who underwent splenectomy surgery during 2010-2020 for any indication in medical centers affiliated to Babol University of Medical Sciences (without a history of this procedure). Their percentage was determined and a decision was made regarding simultaneous surgery of cholecystectomy and splenectomy. Sampling was done by census method and all cases were reviewed and patients were followed up by phone and the necessary information was extracted and recorded in the checklist. Data were described using SPSS 22 software and analyzed at a significance level of 0.05.

A total of 247 patients with an average age of 20.13 ± 3.98 years (minimum age 10 and maximum age 29) were included in the study. The frequency of simultaneous cholecystectomy was reported in 33 cases (13.4%). Out of 214 patients who did not need simultaneous cholecystectomy (57.9%), 183 patients underwent cholecystectomy after splenectomy (85.5%).In 28 people (11.3 percent) had normal ultrasound and 3 people (1.3 percent) died. The prevalence of gallstones was reported as 87.4 percent. It is The average time for cholecystectomy compared to splenectomy in 183 patients who underwent cholecystectomy was 13.41±6.94 months (minimum time interval 3 and maximum 28 months) and in the examination of ultrasound findings, 219 patients (88.7%) had stones. They had a gall bladder and normal ultrasound was reported in 28 people (11.3%).

The study results indicate a high prevalence of gallstones in patients with thalassemia major. Therefore, it suggests that simultaneous cholecystectomy and splenectomy should be considered, even in asymptomatic cases.

Splenic abscess is a rare disease with growing incidence due to the increasing number of immunocompro-mised patients and usage of improved diagnostic imaging modalities. Hematogenous infections are the most common cause of splenic abscess. Because of nonspecific clinical presentation, diagnosis might be de-layed. CT-scan is the imaging method of choice for diagnosis. Ttreatment includes antibiotics alone or antibiotic therapy with percutaneous drainage or splenectomy. In this article, we present a rare case of multiple splenic abscess (MSA) in a patient undergoing hemodialysis in Bushehr.

In most patients, the accessory spleen (AS) is small in size. However, in patients who have undergone splenectomy, AS may hypertrophy. This manuscript presents a rare case of spontaneous AS rupture nearly two decades after a prior splenectomy due to trauma. After searching multiple databases, only a few similar cases have been reported to date. In any acute abdominal patient with a history of previous splenectomy who presents with a mass in the anatomical location of the spleen, along with evidence of hematoma and free abdominal fluid on imaging, the possibility of AS rupture should be considered.

In February 2022, a 36-year-old man who had undergone splenectomy due to trauma 16 years ago was referred to the emergency department at Imam Ali Hospital in Bojnord. He complained of sudden onset of severe abdominal pain, preferably in the upper region of the abdomen. The patient denied having any recent issues. Based on the patient's history and examination, at perforated stomach ulcer and pancreatitis were initially suspected. However, except for leukocytosis, no other abnormalities were observed in the laboratory tests. Ultrasound revealed a low-echo mass-like lesion in the anatomical location of the spleen. Another low-echo mass-like lesion, indicating a hematoma with abundant free fluid in the abdomen and pelvis, was also observed near the aforementioned mass. CT scan confirmed these findings. Open surgical and re splenectomy procedures were performed, and the diagnosis of spontaneous AS rupture was made based on clinical examination and imaging findings.

In any patient with a history of previous splenectomy who presents to the emergency room with diffuse and acute abdominal pain, even without recent trauma, if a mass-like lesion is observed in the anatomically suspicious location of the spleen in the left subphrenic space, along with other evidence of rupture such as hematoma/laceration and free fluid in the abdominal cavity, accessory spleen rupture should be considered as the main differential diagnosis.

Hereditary spherocytosis (HS) is a familial hemolytic disorder with intracorpuscular mechanism that characterized by the production of red blood cells with sphere-like shape prone to hemolysis and can lead to hemolytic anemia, splenomegaly, jaundice and gallstones. One of the main reasons for referring these patients to the operating room is splenectomy and cholecystectomy to treat the complications of HS. Perioperative concerns in these patients include severe anemia with a need for blood transfusion, aplastic attacks, hypoxemia and acidosis. On the other hand, management of anesthesia during splenectomy and cholecystectomy in pregnant woman with HS is very challenging due to physiological changes associated with pregnancy, choosing the appropriate time to perform the surgeries, and complications of anesthesia drugs on mother and fetus. This case study report the management of anesthesia in a pregnant woman with HS, candidate for simultaneous cholecystectomy and splenectomy.

Spleen is an immunologic organ and has critical role in prevention of capsulated microorganism infection. Accessory spleen after splenectomy is important due to this immunologic effect. On the other hand, accessory spleens should be considered in differential diagnosis of abdomino-pelvic masses. In this report, we present a rare case of pelvic mass with final diagnosis of autoimplantationof accessory spleen on the mesentery of the rectum.

The patient was a 32-year-old nulligravidarum woman with history of primary infertility and previous splenectomy due to spleen trauma in childhood without the history of hospitalization due to infection. The imaging results showed solid and hypervascular pelvic mass following IVF assessment.
The patient was admitted in Gynecology Oncology Surgery Section in Emam Khomeini hospital, Tehran University of Medical Sciences. She underwent laparotomy, and the result due to the frozen section pathology, was reported as accessory spleen.

Abdominopelvic masses with normal serum tumor marker, especially in patient with previous trauma and splenectomy, should be considered in differential diagnosis of accessory spleens, and should be confirmed with exact assessment by nuclear scan or laparoscopy, so that by accidental resection of these kind of masses the immunological safety of patients wouldn't be at risk.

Splenic hematoma is one of the common complications following abdominal blunt trauma, but non-traumatic splenic hematomas are not common and occurs in some cases, such as hematologic disorders and/or infections. Idiopathic splenic hematoma that occurs spontaneously without an underlying disease, is a rare occurrence, which its diagnosis needs strong clinical suspicion. Case report: The patient was a young man who referred to the emergency department with sustained lower abdominal pain during the past day. The pain aggravated by bending and was worsened by lying down. The patient reported no specific concomitant symptoms. His past medical history and drug history were negative. Chest x-ray and laboratory tests did not show any abnormal finding. In the upright radiograph of the abdomen, the shadow of the spleen seemed larger than the normal size. Abdominal sonography showed extensive subcutaneous hematoma of the spleen, which was confirmed by CT scan. The patient was under observation in the intensive care unit for 48 hours, that due to the pain intensification of the candidate, the splenectomy was performed. Pathologic study of splenic tissue was normal and he discharged within one week with satisfactory general health condition.

  Thalassemia syndromes are hereditary disorders of alpha and beta globin band. Nowadays with appropriate treatment for this group of patients, their survival rate has significantly increased. But it has led to new complications like pulmonary hypertension that were not possible events to experience before. This study investigates the frequency of pulmonary arterial hypertension among patients with beta thalassemia.

In this descriptive study, pulmonary hypertension was evaluated by echocardiography among 50 patients with beta thalassemia who referred to our Sanandaj University Hospital, Besat during 1393-1394. Demographic and Echocardiographic findings besides lab tests were evaluated and compared between subgroups.

Among 50 participants, 8% had pulmonary hypertension. In subgroups, pulmonary hypertension was found in 15.4% of children, 5.4% of adults, 8.2% of patients with high ferritin, 11.5% of patients with thrombocytosis, and 8.2% of patients who had splenectomy.

Frequency of pulmonary hypertension among our patients is less than previously published studies with higher rate among children. Also the present study showed thrombocytosis and splenectomy as associating factors among thalassemia patients with pulmonary hypertension

Background and Increased pressure in the pulmonary circulation is of the major factors causing cardiac disorders in patients with thalassemia. The aim of this study was to investigate the relationship between splenectomy and pulmonary arterial pressure in individuals with beta- thalassemia major.
A cross-sectional study was carried out in patients with beta- thalassemia attending Hajar Hospital Shahrekord, Iran, 2015. All patients underwent echocardiography and the hemoglobin levels, platelet count, ferritin, pressure, pulmonary arterial pressure, etc. were measured. Data analysis was done in Stata 13.
Among the variables measured, the average age, hemoglobin level, platelet count, nucleated RBC, lactate dehydrogenase, tricuspid regurgitation flow, pulmonary arterial pressure, right diameter, main pulmonary diameter, left ventricular end diastolic diameter, left ventricular end systolic diameter were found to be higher in patients with splenectomy, compared to those of the patients without splenectomy (P> 0.05). Significant correlation was observed between platelets, NRBC and the time of splenectomy with pulmonary artery pressure (P 0.05).
The results showed that splenectomy could increase the susceptibility to pulmonary artery pressure in patients with beta thalassemia major or lead to the progression of pulmonary hypertension in this disease.

Introduction & Previously it was thought that spleen is not an important organ with special function. Therefore the elected treatment of spleen diseases has been full splenectomy. By greater recognition of the spleen function and its important role in the body physiology، it was found that full splenectomy causes immunocompromised increasing in the individuals and made them prone to certain infections and the risk of tromboemboli. The present study was conducted for precise analysis of the immune system changes، including immunoglobulin levels with regard to the study of tissue changes and the regeneration of the transplanted spleen، in order to achieve proper performance with the hope of reducing the complications of inevitable splenectomy especially due to post-traumatic ones. In an interventional and cross-sectional study، 19 patients over 12 years old with blunt trauma، who، were suffering from severe splenic blunt trauma in 2013/14، based on the treating physician’s diagnosis were full splenectomy candidates، came under our study. Patients with census and giving written consent were included in study. After the approval of the patient Candidacy for of splenectomy، necessary explanations were provided to the patients and lack of exclusion criteria، patients were evaluated and eventually graft surgery was performed on them. Finally، all the patients’ informations were entered into SPSS version 16 and were analyzed. Measures of central tendency and dispersion (mean and standard deviation) of charts and graphs were used for data analysis in descriptive statistics. In inferential statistics، repeated measures test were used and in case of abnormal data its equivalent Friedman test were used. In the present study، a total of 19 patients with an average age of 42. 58±18. 78 years old of which 14 (%73. 7) were male، were studied. The results of the univariate analysis showed a statistically significant difference (P=0. 024) in the rate of lymphocyte over time (before the surgery، 3 months after the surgery and 6 months after the surgery). However the variables hemoglobin (P=0. 192)، red blood cells (P=0. 177)، hematocrit (P=0. 192)، platelets (P=0. 221)، and leukocytes (P=0. 071) revealed no significant difference. The presence or absence of Howell bodies indicated a significant difference (P=0. 042)، over time so that the Howell bodies in the 6 months before surgery were less than 3 months after surgery. The difference between average spleen phagocytic at 3 months after surgery and 6 months after surgery was significant (P=0. 044). In fact، the average spleen phagocytic at 6 months after the surgery was higher than that of 3 months after the surgery. Based on the results of this study، by increasing the time as well as transplanted chips، the difference between the individuals with auto transplanted spleen and those with healthy spleen can be reduced to the lowest possible rate. Auto transplantation of Spleen has been proved to be a very appropriate alternative therapy to splenectomy.

Spleen is known as the largest lymphoid organ in human body and is responded orthe blood filtration; strengthen the immune system activity, hematopoiesis. Trauma and congenital problems are the most common indications for splenectomy. The aim of this study was evaluation the ten-year indications of splenectomy in Tabriz Children's Hospital. In this retrospective study that the hospital recors of all cases who underwent splenectomy in Tabriz Children's Hospital was studed and the indications of splenectomy in these children evaluated. Thirty four children were boys and 35 of studied children were girl. Mean age of boy children was 99.20 ± 42.77 months and the mean age of girl children was 125.42 ± 35.24 months (P=0.007). Major beta-talassemia (n=23) was the most common indication for splenectomy in studied children. Spleen size in 22 children was normal and in 47 children spleen size was great. Platelet drop in two cases, port vein thrombosis in 3 cases, heard failure in two cases, sepsis, recurrent meningitis, sepsis and CVA in one of the studied children were postoperative complication of study. Only seven cases of studied children were died after surgery that two cases of mortality causes was heart failure due to talassemia. In our study, trauma in 3 cases (4.34%) of the studied children was the splenectomy indications that one of these children had died. Major beta-talassemia, hereditary spherocitosis and idiopathic thrombocytopenic purpura were the most common causes of spelenctomy in the studied children and in our study, 5 of children with talassemia were died that 2 causes was heart failure due to talassemia, 2 cases due to port vein thrombosis and one case due to CVA. Postoperative complication rate was 23.18% and risk of infection and sepsis in our study was 3.07% and also the mortality rate in our study was 10.1%.

Splenectomy considered as second line therapy in management of patients with idiopathic thrombocytopenic purpura (ITP) whom did not respond to corticosteroid or the platelet decreased after corticosteroid cessation. The aim of the present study was to determine the response to splenectomy in chronic ITP patients. This retrospective cohort study was performed on all patients with ITP who underwent splenectomy at Shahid Beheshti and Yahyanejad hospitals during 10 years. Age، sex، time of initial treatment، time of surgery، platelet counts at time of diagnosis، pre- and post-operative platelet counts، respond to treatment and receiving treatment، extracted from the patient''s registry. From 41 patients، the immediate postoperative response was partial in 4 patients (9. 8%) and complete in 37 patients (90. 2%). Non-response was not seen in any patient. The median follow-up was 12 months (range: 1-101 months). In long-term follow up، complete response (CR) was achieved in 4 patients (85. 3%) and partial response was achieved in 2 (%4. 9) of patients and treatment failure was achieved in 4 patients (9. 8%). According to the results of this study، many of patients with ITP who underwent splenectomy have long term remission and splenectomy is a safe and effective method of treatment for these patients.

. With regard to the interactions between brain and spleen, in this research, the effect of splenectomy on PTZ-induced epilepsy in Wistar rats was studied . In this study, 48 male and female wistar rats were used in 3 groups. Experimental groups for each of the two sexes included the negative control, positive control and splenectomy. Negative controls did not undergo surgery. The incision was created in the positive control group, but the spleen was not removed. The spleen was removed in splenectomy group. After seven days, PTZ was injected and the ‌initiation time of different convulsive stages in terms of seconds and score of seizures in the three groups with the same gender were compared using one-way ANOVA.. Second stage of convulsive seizures in the splenectomy group of male rats in comparison with control groups decreased significantly. Fourth stage of seizure in female splenectomized rats in comparison with negative control group decreased significantly. Also score terms of seizures in both male and female rats were not significantly different in the three groups.. Splenectomy intensifies PTZ-induced seizures in Wistar rats.

Introduction & Splenectomy is among the operations that are performed laparoscopically nowadays. One of the challengaes in this surgery is hilar vessels ligation. It is especially critical about the spleen which is prone to hemorrhage and its resection is based on hilar vessels ligation. Ligasure which ligates the vessels with bipolar electrical activity seems simple, effective and safe. The purpose of the current study was to evaluate the function and safety of ligasure in performing laparoscopic splenectomy and its possible complications. This was a descriptive study to assess safety and weakness of Ligasure in laparoscopic splenectomy. The study carried out on patients with idiopathic thrombocytopenic purpura (ITP) who needed splenectomy in Shariati hospital. During the study period, 35 patients with ITP underwent laparoscopic splenectomy with Ligasure vessel sealing system. We assessed surgery duration, intraoperative and postoperative bleeding, decrease in hemoglobin due to surgery, need to blood transfusion during or after surgery, and need to conversion to open surgery as well as post operative complications and hospital stay. 35 patients were included in this study, with the mean age of 31.5±9.2 years. 25 patients were male and 10 were female. Mean operative time was 132±40 minutes. Intraoperative bleeding volume was 145±103 ml. Decrease of hemoglobin level due to surgery was 1.8±1.1dL. Postoperative hospital stay was 3.8±1.4 days. None of the cases converted to open surgery. Intraoperative or postoperative blood transfusion was required for three patients. The amount of bleeding from abdominal drain was 104±90 cc. According to the result of our study, ligating hilar vessels of spleen with ligasure in patients with ITP is safe in laparoscopic surgery which results in appropriate hemostasis without major bleeding during or after operation. Thus, this method is recommended in the case of laparoscopic splenectomy of patients without splenomegaly, such as idiopathic thrombocytopenic purpura.

Recognition of the importance of splenic immune function has prompted the surgeons to preserve the upper part of the spleen on the base of short gastric vessels after splenic trauma. This study aims at evaluating the function of upper pole of spleen in patients with traumatic injury to the spleen. In a clinical trial, 30 patients with traumatic injury to the spleen were evaluated in Tabriz Imam Hospital. They were categorized in 3 ten-patient groups: controls that treated conservatively, cases with preservation of the upper pole of spleen, and the group underwent total splenectomy. Duration of hospital stay and in-hospital complications, as well as the blood peripheral smear and serum levels of IgG and IgM, 3 months after discharge was compared between the groups. No major complications or need of reoperation were documented in any patient during hospital stay. In radioscintigraphy of the remnant spleen in the cases group after 3 months, all the cases were functional. Mean serum level of IgM was significantly lower in the total splenectomy group comparing with the controls. However, the mean serum level of IgG was not significantly different between the groups. Abnormal morphology of red blood cells in the peripheral smear was significantly more frequent in the total splenectomy group comparing with the other two groups. According to our results, subtotal splenectomy with saving the upper pole along with the short gastric vessels is superior to the total splenectomy in managing the traumatic spleen injuries.

Background and ObjectivesThrombotic events are among the most important complications in patients with beta-thalassemia major. Alterations in natural anticoagulation system have a major contribution to the occurrence of thrombotic events in these patients. This study was performed to evaluate the protein C, protein S and Antithrombin III activity in patients with beta-thalassemia major having referred to Mofid Children Hospital in 1382.Materials and MethodsThalassemic children older than 2 years of age, with the interval of more than 25 days since last transfusion, and without any evidence of symptomatic liver or heart disease were enrolled in the study. Plasma activity of protein C and protein S was assessed by PTT based tests and the activity of antithrombin III was determined by chromogenic method. The correlation between decreased levels of anticoagulants and other parameters such as splenectomy, liver transaminases and serum ferritin level was analyzed by spss software.T-test and Mann whitney U-test were used to compare the mean values of variables.Results20.3% of patients showed a decrease in protein C and 15.3% in protein S. 12 patients had been splenectomized. Mean protein C activity in splenectomized and non-splenectomized patients were 63.4 ± 17.9% and 74.5± 15.1%, respectively (p<0.04).ConclusionsThere was a decrease in proteins C and S activity in thalassemia major patients. Splenectomy might cause reduction in protein C level. Analytic studies are recommended to evaluate the activity of anticoagulant system in thalassemic patients. In addition, assessment of this system is suggested prior and after splenectomy.

Splenic cyst is not a common disease. Robbins reported 32 primary splenic cysts from 42327 autopsies examined during 25 years. Splenic cysts are divided into two groups: parasitic and non-parasitic cysts. Splenic cysts are clinically divided to primary and secondary cyst. Ten % of and are primary or true splenic cysts. Because these cysts have non-specific symptoms like vague abdominal pain, abdominal distension and dyspnea, they may become huge by the time of diagnosis. Proliferation of epithelial cell and increased secretion of this cyst layer may be the cause of the growth. The traditional treatment is splenectomy.Subjects and In this case report, a 17-year male old patient with signs of weakness, abdominal distension, and mild dyspnea, which had begun 8 months ago, is presented. On Sonography we found a huge 217x 166 x 301 mm cyst in his spleen. Laparatomy revealed splenic cyst 30x 20x20cm with the same the same pathology. After splenectomy patient was completely cured and left the hospital with a good general condition.